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“When you were young, abortion was a dirty word; it’s not anymore,” actress Adrienne Barbeau’s character said in a seminal 1973 episode of Maude that aired two months prior to the Supreme Court’s decision to legalize the act. She said it to convince her mother (and viewers at home) that the taboo of an abortion ruining a woman’s existence and sense of purpose had lifted. While not a light or painless decision, it was one that many women made and then continued to carry out their lives. “Now you think about that.”

Wednesday marked Roe v. Wade’s 41st anniversary and provided an opportunity for reflection. But when we try to think, as Barbeau suggested four decades ago, about how television has continued to erase abortion’s taboo and honestly portray the full spectrum of a character’s decision-making process when it comes to dealing with an unwanted pregnancy, we don’t really have a lot of material to work with.

“It’s a polarizing issue obviously,” Grey’s Anatomy, Private Practice and Scandal creator Shonda Rhimes told TIME. And that’s why the showrunner thinks that television, which has the ability to bring issues to light and ignite national conversations, has an obligation not to ignore it. “Because it is such a hot button issue, because people are debating it, it should be discussed. And I’m not sure why it’s not being discussed.”

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Shonda Rhimes.

In an ideal world, television reflects real life. At the very least, it should touch upon real-life issues. But that’s never really happened with abortion, said Planned Parenthood VP of Communications Eric Ferrero: “I think a discussion on how abortion is treated on TV is often a very short discussion because it’s very rare. As you go back and look at Maude and Friday Night Lights and Grey’s Anatomy and Parenthood, in terms of rich portrayals it’s a very short list. Even if a character is weighing her options, abortion won’t be spoken about, which only [increases] the shame.”

Far more consistently, Ferrero notes, characters conveniently miscarry (90210, Party of 5, Gossip Girl, Revenge, Girls) to negate any need for a decision or consequential trope, or have last minute changes of hearts (Sex and the City, Dawson’s Creek, Secret Life of An American Teenager).

“We had some of this in the ’90s and early 2000s where there would be characters who had an abortion, and then they were killed off,” Ferrero said. “We take our progress as we can, I guess.”

But even for proactive showrunners, integrating abortion into plotlines, particularly with main characters, can be complicated.

In season one of Grey’s Anatomy, Dr. Cristina Yang — brilliant, motivated, but not yet beloved by national audiences — got pregnant. Rhimes planned for the lead (played by Sandra Oh) to have an abortion. That didn’t happen.

“Now, it’s a first season show, it was nine years earlier or whatever, and the network freaked out a little bit,” Rhimes said. “No one told me I couldn’t do it, but they could not point to an instance in which anyone had. And I sort of panicked a little bit in that moment and thought maybe this isn’t the right time for the character, we barely know her… I didn’t want it to become like what the show was about.”

And thus, come season two, rather than have the abortion she had been planning, Yang suffered an ectopic pregnancy. She experienced a fate similar to that of many hesitant television protagonists who had come before — and would certainly follow.

“And it bugged me,” said Rhimes, who serves on the board of Planned Parenthood Los Angeles. “It bugged me for years.”

So in 2011, when Yang was happily married, accidentally pregnant, but still absolutely uninterested in reproducing, Rhimes had the chance to tell the story again but with a different result.

“I felt like we had earned all of the credentials with the audience,” she said. “The audience knew these characters. The audience loved these characters. The audience stood by these characters. You know, we were in a very different place even politically, socially. Nobody blinked at the studio or the network when I wrote the storyline this time. Nobody even brought it up except to say, that was a really well written episode.”

Cristina underwent the operation as her husband held her hand. While the marriage didn’t last — not ending in vitriol but rather because he wanted a family, it simply (but respectfully) wouldn’t work — Yang stayed true to her convictions and carried on as a whole character.

Ferrero believes that television, even more so than film, has the unique ability to put complex situations in the larger context of people’s lives. “Part of why television is so important is that it’s both able to show the complexity of these experiences, but it also puts the ability to have an abortion into a character’s life because you’re with these characters for months and years,” he said.

Still, most accidentally impregnated characters, even young women who have only lived in a post-Roe v. Wade world, don’t bring up or even briefly consider the option of an abortion. It is as if it doesn’t even exist. “And [that’s] weird and not realistic,” said Rhimes.

As much as Rhimes is interested in a sincere story about a woman agonizing over the decision to abort or keep a child (which is “just as valid of a choice”) or applauds discussion of adoption, “let’s be serious about what’s really going on. I would prefer that they do story lines about people getting and using birth control rather than doing stories about people accidentally ending up pregnant and then keeping their babies.”